Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture

Bartha, Erzsébet; Arfwedson, C.; Imnell, A; Fernlund, M.E.; Andersson, Lars; Kalman, Sigridur

doi:10.1093/bja/aes468

Cited by 69 publications

(78 citation statements)

References 26 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The recognition and management of hypovolaemia in this population is challenging despite improvements in perioperative care. Bartha et al [6], in a recently reported trial of goaldirected therapy in hip fracture, had a response rate to fluid challenge of 37/142 (26%), which is similar to Canty et al's findings. Interestingly, Bartha and colleagues did not demonstrate the marked difference in mortality that Canty et al found.…”

Section: Kaufmansupporting

confidence: 78%

Chlorhexidine arachnoiditis

Kaufman

2013

Anaesthesia

View full text Add to dashboard Cite

Section: Kaufmansupporting

confidence: 78%

Chlorhexidine arachnoiditis

Kaufman

2013

Anaesthesia

View full text Add to dashboard Cite

“…The risk of hypovolaemia may be reduced by limitation of starvation times and with intravenous fluid administration before and during surgery. Intraoperative stroke volume guided fluid studies are currently underpowered to demonstrate statistically significant changes in development of AKI [46, 47] and echocardiography studies [48] suggest that around 25% of patients are still hypovolaemic immediately prior to theatre. Patients arriving in theatre with urinary evidence of ‘dehydration’ [49] also have a worse outcome.…”

Section: Discussionmentioning

confidence: 99%

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

et al. 2017

View full text Add to dashboard Cite

BackgroundHip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.MethodsAn observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.ResultsData were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).ConclusionsAcute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.

show abstract

“…Multiple single-center studies have shown that perioperative GDT may significantly improve outcome, particularly in patients undergoing abdominal surgery [3-5], but also in trauma [6,7] and orthopedic surgery [8]. All these studies were single-center studies which makes the meta-analysis that dealt with these highly divergent studies hard to interpret [9].…”

Section: Introductionmentioning

confidence: 99%

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

et al. 2013

View full text Add to dashboard Cite

IntroductionSeveral single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).Methods160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.ResultsThe total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).ConclusionsThis multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.Trial registrationClinicalTrial.gov, NCT01401283.

show abstract

Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture

Abstract: The magnitude of risk reduction of postoperative complications is clinically relevant, but the trial was underpowered and the null hypothesis cannot be rejected.

Cited by 69 publications

References 26 publications

Chlorhexidine arachnoiditis

Chlorhexidine arachnoiditis

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

Contact Info

Product

Resources

About